1710940309 NPI number — VINCENT O. CASIBANG, M.D., P.A.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710940309 NPI number — VINCENT O. CASIBANG, M.D., P.A.

Employer Identification Number (EIN):

Provider Organization Name:

VINCENT O. CASIBANG, M.D., P.A.

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1710940309

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/22/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 886

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LANHAM

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

20703-0886

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

301-731-5944

Provider Business Mailing Address Fax Number:

301-731-9034

Provider First Line Business Practice Location Address:

9470 ANNAPOLIS RD

Provider Second Line Business Practice Location Address:

SUITE 307

Provider Business Practice Location Address City Name:

LANHAM

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

20706-3025

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

301-731-5944

Provider Business Practice Location Address Fax Number:

301-731-9034

Provider Enumeration Date:

04/06/2006

Authorized Official Last Name:

CASIBANG

Authorized Official First Name:

VINCENT

Authorized Official Middle Name:

ONATE

Authorized Official Title or Position:

CORPORATE PRESIDENT

Authorized Official Telephone Number:

301-731-5744

• Taxonomy code: 174400000X , with the licence number:  D0023927 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 4051226 . This is a "AETNA USHC TRADITIONAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 73 0339 4 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 82716 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 24311 . This is a "MAMSI/OPTIMUM PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 98920001 . This is a "BCBS NCA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 9892 . This is a "CAPITAL CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 0412120(023267500) , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
• Identifier: 327264 . This is a "PRIME HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 94912 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 02244 VO02 . This is a "BCBS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 67535 . This is a "AMERIGROUP PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".